Murat Çap, MD
213 posts



I’m still living in the world of the meta-analysis published just last week😁before IVUS-CHIP and OPTIMAL. Keep using IVUS!




Thank you @realarainmd for posing such a thought-provoking question. I believe that ORBITA-CTO is eagerly awaited by all cardiologists, especially those in the CTO community. Many CTO operators are expecting a result that supports their perspective that CTO opening offers benefits beyond a placebo effect. However, regardless of the outcome, the debate is likely to continue. I would also like to specifically thank @rallamee for introducing the concept of “ORBITA-like” into the medical literature. 2/


All About That Bias! Here is a short field guide to the biases that can be found within many observational studies. Courtesy of @ihtanboga. 🙏🏼

PCI vs. PCI - More reflections on the study by Gim et al The sticking point for me (and others like @aymanka, @ihtanboga, @GreggWStone) is the immediate separation of the curves bet. the PCI arms. It is difficult to see how immortal time bias alone accounts for this. doi: 10.1016/j.jcin.2025.11.036

Study conclusion: Angiography guided PCI was associated with significantly higher risk for MACE, However, IVI-guided PCI had comparable risk with CABG in DM patients. But there's a methodological concern hiding in the study design that the authors didn't discuss: Immortal time bias. 1/



7. and summary


There is one thing that, even as a reviewer and despite having pointed it out during the process, I really haven't understood about the new ESC guidelines for chronic coronary syndromes. Using the new Risk factor-weighted clinical likelihood (RF-CL) model, one can calculate individual risk based on symptoms, sex, and the number of cardiovascular risk factors, and so far so good. In this way, the calculable pre-test probability scores range from 0 to 45%. However, the recommendations for additional diagnostic tests are also applicable to patients with a risk higher than 45%. Now, how does one calculate a pre-test probability higher than 45% based on the RF-CL? With risk enhancers like PAD, resting ECG, etc.? With the calcium score? In fact, the calcium score can be used to determine the new pre-test probability, but I don’t think this is a good reason to perform it on everyone, also because its value lies mainly in recategorizing patients into the very low-risk group when it is zero. However, it seems you cannot determine the new pre-test probability with risk enhancers, unless it is meant that the presence of one of these factors automatically shifts the patient into at least the moderate-risk category. In short, if anyone has figured out how to arrive at the precise number for values above 45%, they’d be doing me a favor, because I can't understand it from the text.
